title: Age-, body size-, and sex-specific reference values for right ventricular volumes and ejection fraction by three-dimensional echocardiography: a multicenter echocardiographic study in 507 healthy volunteers.
abstract: BACKGROUND
  Right ventricular (RV) volumes and ejection fraction (EF) vary significantly with demographic and anthropometric factors and are associated with poor prognosis in several cardiovascular diseases. This multicenter study was designed to (1) establish the reference values for RV volumes and EF using transthoracic three-dimensional (3D) echocardiography; (2) investigate the influence of age, sex, and body size on RV anatomy; (3) develop normative equations.
  
  
  RESULTS
  RV volumes (end-diastolic volume and end-systolic volume), stroke volume, and EF were measured by 3D echocardiography in 540 healthy adult volunteers, prospectively enrolled, evenly distributed across age and sex. The relation of age, sex, and body size parameters was investigated using bivariate and multiple linear regression. Analysis was feasible in 507 (94%) subjects (260 women; age, 45 ± 16 years; range, 18-90). Age, sex, height, and weight significantly influenced RV volumes and EF. Sex effect was significant (P<0.01), with RV volumes larger and EF smaller in men than in women. Older age was associated with lower volumes (end-diastolic volume, -5 mLdecade; end-systolic volume, -3 mL/decade; EF, -2 mL/decade) and higher EF (+1% per decade). Inclusion of body size parameters in the statistical models resulted in improved overall explained variance for volumes (end-diastolic volume, R(2)=0.43; end-systolic volume, R(2)=0.35; stroke volume, R(2)=0.30), while EF was unaffected. Ratiometric and allometric indexing for age, sex, and body size resulted in no significant residual correlation between RV measures and height or weight.
  
  
  CONCLUSIONS
  The presented normative ranges and equations could help standardize the 3D echocardiography assessment of RV volumes and function in clinical practice, considering the effects of age, sex, and body size.
authors.affiliation: Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maffessanti
authors.forename: Denisa
authors.initials: D
authors.lastname: Muraru
authors.forename: Roberta
authors.initials: R
authors.lastname: Esposito
authors.forename: Paola
authors.initials: P
authors.lastname: Gripari
authors.forename: Davide
authors.initials: D
authors.lastname: Ermacora
authors.forename: Ciro
authors.initials: C
authors.lastname: Santoro
authors.forename: Gloria
authors.initials: G
authors.lastname: Tamborini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
authors.forename: Luigi P
authors.initials: LP
authors.lastname: Badano
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D049628:Body Size; D019560:Echocardiography, Three-Dimensional / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007558:Italy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D012737:Sex Factors; D013318:Stroke Volume; D016278:Ventricular Function, Right; D055815:Young Adult
keywords: allometric equations; echocardiography, three-dimensional; reference values; right ventricular ejection fraction; right ventricular volumes